LISTENER (N.Z.), November 17, 2001.

The First Cut

As circumcision rates drop, several generations of Kiwi
males now look slightly different to their dads. But will we
follow some countries and legislate?

BY ALISTAIR BONE

On June 1, the
Swedish parliament passed a groundbreaking new law. The
legislation was aimed at Sweden's burgeoning Muslim
population, to whom the practice of circumcision is a holy
writ, and too many of whom were presenting their mutilated
infants at hospital emergency wards after botched backyard
operations. Now circumcision in Sweden can only be carried
out on boys under the age two months, and a registered nurse
or doctor must give local anaesthesia. Male who have reached
the age of consent can also decide to have it done. The
reaction was immediate and vocal. The loudest response came
from the Jewish community, for whom the practice is also part
of a holy covenant with God. "People have compared the
regulation to those of Nazi Germany implemented against the
Jews," complained the chairwoman of Stockholm's Jewish
community. "I think the backlash will be tremendous around
the world said Stockholm's Rabbi. It is indicative of the
heat of the debate that such comments are made about a simple
medical safeguard for a minor operation. Circumcision, a
process widely derided by many surgeons and GPs as of no
benefit and of negative effect, yet fiercely defended as a
vital part of cultural and religious identity by others, is
the anachronism that refuses to die.

Hard figures are difficult to come by on the
local circumcision scene. The New Zealand Medical
Association's best guess is that around 10% of baby boys
are circumcised. Other research indicates a wide cultural and
racial split, with only about 1% of caucasian boys, but
nearly 100% of Tongan, Samoan, and Jewish boys, currently
having the operation done. Australia has similar figures to
us, but in the US nearly 63% of babies are circumcised and in
the UK somewhat less than 4%. It is relatively unknown in
continental Europe, South America and non-Muslim Asia.

The origins of the practice are older than all
major religions and recorded history. No one can remember why
we do it. Outside of the wishes of a deity, or as rite of
passage, there have been a number of medical justifications
put forward, including- a cure to masturbation, epilepsy,
eczema, idiocy, and headaches. Recently, it has been touted
as preventing urinary tract infections, penile cancer and
Aids. "Rubbish," says senior lecturer in pathology at Auckland University of
Technology and anti-circumcision campaigner Ken McGrath.
"The urinary tract justification is one of the worse studies
I have seen in terms of bad design bias, incompetence in
structuring the study and iatrogenic effects [investigators
causing the infections]. They have been rubbished and never
duplicated. I don't think anyone with any scientific
discrimination would accept them.

Similarly, the penile cancer myth "That has been
debunked since it came out, again it has never been
replicated and there have been consistent reports of cancer
in the circumcised male. There are four times more incidence
of breast cancer in males than penile cancer anyway, but no
one is suggesting you cut off men's nipples, even though you
would do four times as much good if you did that to every boy
rather than mucking about with their penis." And Aids? "That
study really is silly - it has a truck driven through it. It
has a serious set of statistical biases. Also, it suggests
that the foreskin is at risk because it contains Langerhans
cells. The cells are found in all skin. I predict that Aids
will disappear as a reason, too, within five years they will
have to find another reason for justifying circumcision -
apart from money and cultural imperialism."

Money is certainly a factor. Southern Cross
Healthcare's median payment for the operation was $1445
in 1999. A limited US study found that the the median charge
was $US121. Circumcision opponents in that country estimate
the total cost at up to $US2billion a year (McGrath says
$US200million is more believable), and at least one US doctor
dines out on the line that "Every American boy is born with a
$100 bill under his foreskin. All you have to do to get it is
take it off."

Reduced sexual pleasure is another cost in the
circumcised male. Sixty percent of the skin of the foreskin
is removed during circumcision and with it goes most of the
penis' epicritical sensory system - complex transducers with
very high resolution in sensitivity equivalent in sensitivity
to the fingertip. What is left on the glans itself are the
protopathic pathways, a very simple system of free nerve
endings equivalent to in sensitivity to the heel of the
foot.

Some research suggests disruption of
circulation, bad hygiene and even neurological damage are a
possibility, even after a successful operation. Curvature of
the penis is also present in about 70 percent of circumcised
males, and almost non-existent among the uncircumcised, but
most medical complications stem from a botched procedure.

Dr Percy
Pease has been a consulting paediatric surgeon with a
specialty in pediatric urology for 27 years. He sees about
one botched circumcision a month. "It is usually when too
much skin has been taken off, generally people from the
Pacific Island community." He has noted a drop in the number
of people having the procedure done. "Even some European and
New Zealand Jewish people are not having their kids
circumcised. People question what the validity of it is when
it is botched and have a hard time dealing with the guilt.
I'll do them if people insist, only because I can do them
properly." Currently the New Zealand Medical Association
recognizes no preventative medical health benefits from
circumcision. The British
Medical Association considers it a radical invasive
procedure and states that unless conservative treatments are
tried first a therapeutic circumcision would be
unethical.

"Even some European and New Zealand Jewish
people are not having their kids circumcised. People question
the validity of it when it is botched and have a hard time
dealing with the guilt."
--DR PERCY PEASE

In New Zealand, the debate is just getting
under way and seems likely to focus on human rights. As a
signatory to the binding International Covenant
on the Rights of the Child, we have agreed to "...take
all effective and appropriate measures with a view to
abolishing traditional procedures prejudicial to the health
of children". Which some see as a warrant to ban the practice
of ritual male circumcision. "The religious and cultural
thing can be solved by letting the 16-year-old make his own
decision," says McGrath.

The heat in the local argument indeed lies with
those who seek to outlaw the process rather than those who
seek to maintain the status quo. Orthodox Jewish Rabbi Jeremy
Lawrence is relaxed about the new Swedish law. "There is
every legitimate right for a government to make sure
religious practice can be done within suitable medical
paradigms," he says, but adds that a spiritual dimension may
be lost by interfering with the ministrations of the Mohel,
the person in Jewish culture who traditionally performs the
circumcision.

Rabbi Lawrence objects to delaying the process
until the child is of an age where he can legally consent.
"Certainly it is much harder for someone who is older or
sexually active to contemplate having that procedure.
Deferring consent until it becomes more informed means you
are creating a psychological barrier to changing who you are.
If you say that a person is more able to weigh up the pros
and cons when they are older, that may be true, if that is
your sole value and criterion. If you say a child has a right
to be brought up with a its heritage [another part of the
International Covenant], to bring up a child alienated from
what God has set out for them is a fundamental breach of the
human right to spiritual and national identity."

Similar views exist with in Pacific
Island society. Traditional Pacific Island Circumcision
practice is different for European, a "dorsal slit" or
supercision is usually performed on boys between nine and 15.
This practice is not as damaging to the foreskin, although it
also has the effect of toughening the glans and making it
less sensitive.

Dr Sitaleki Finau is a senior lecturer at
Auckland Medical School and Professor of Public Health at the
Fiji School of Medicine. He dismisses anti-circumcision views
on penile cancer and Aids. "Those who argue are those who
don't understand the literature," he says. The practice was
well established in the islands even before Christianity
endorsed it. "If you're not circumcised, you are not a man,
you haven't gone through the rites of passage and you are
considered dirty." There are three Pacific-run clinics in
Auckland that perform the operation for a break-even fee of
$150. The clinics provide a check-up service as part of that
fee. "We find hepatitis B, anemia, worms, that type of thing
and treat them, too, and some of these kids haven't seen a
doctor for a long while. About 280 kids have been done in the
last couple of years and the practice of backyard
circumcisions is starting to disappear." And the question of
rights? "To whom does the child belong?" says Finau. "My
stance is that if parents are responsible for children, they
should be responsible for the decision made on behalf of
children. Why is the penis different from the ear or ear
piercing? It is less dangerous than liposuction or a facelift
or any of those other things people do for fun."

The Swedish model would be a particularly good
thing but is not applicable in the current hostile climate.
"If circumcision was accepted in New Zealand we could develop
a guideline, but there isn't one. If the medical profession
doesn't accept it and it's becoming a lost skill."

The Commissioner for
Children, Roger McClay, will be in the thick of the
emerging debate. "If I was a newborn baby tonight and I could
speak, I would say, 'Can you hold off a bit until I can make
up my own mind.' But, by the same token, would a child want
to grow up in a culture or with a religious belief of its
parents and be different from everybody else?" The difficulty
is in deciding it. But we should be talking about it." It is
a very hard one. I would like to see a debate. It would be
worth raising and it needs to be.

Cite as:

Alistair Bone. The First Cut. The Listener.
(N.Z.), November 17, 2001: pp. 31-32.